Why I decided to have a knee operation

I’m sitting at home now recovering from a knee operation I had yesterday. I had my anterior cruciate ligament (ACL) reconstructed and a tear in the meniscus repaired with a couple of stitches. The ACL is a ligament that runs from the front to the back of the knee and gives the knee stability. The meniscus is a disc of cartilage that sits on top of the tibia (shin bone).

I first injured my ACL some six or seven years ago skiing. I was transitioning from snowboarding to skiing and had just got good enough with the two planks to feel I could take on the mountain but hadn’t yet understood that it is much easier to hurt yourself on skis than it is on a snowboard. So I skied into an area I shouldn’t have been attempting and twisted my knee in a fall. I had maybe a dozen physio sessions when I got back and the knee was OK, but never great. Then at the beginning of last year it collapsed on me whilst skiing and then whilst playing football. It got a bit better but then went again in the summer when I was dancing in the silent disco at the Rewind Festival. All the coolest people injure themselves dancing in silent discos…

This collapse was worse than the previous ones because I also injured my meniscus. I had a bunch of physio during the autumn, but kept suffering from knee irriation and couldn’t play football without it hurting. So in December I went for an MRI which revealed that my ACL was fused to the posteria cruciate ligament rather than the patella (knee cap), presumably a result of incorrect healling after the ski injury of six or seven years ago.

My consultant gave me the choice of fixing the meniscus tear and reconstructing the ACL so it was fused in the right place or just fixing the meniscus tear. It was a difficult choice because most of the time my knee was fine. I could run and cycle without problems, and skiing was fine most of the time. I even considered not having surgery at at all. In the end I evaluated the options like this:

No surgery – benefit – knee works fine under most circumstances and no risk of an imminent step backwards due to complications in surgery, con – couldn’t play football with the kids very much, knee seems to be getting more unstable over time, risk of early arthritis

Fix the meniscus tear – benefit – would be able to play football again, relatively minor surgery compared with an ACL reconstruction, con – doesn’t address the stability or arthritis issues

Fix the meniscus tear and reconstruct the ACL – benefit – prospect of a fully working knee, con – ACL reconstruction is a majory surgery with accompanying chances of complications, including major loss of knee function (small chance)

The consistent advice I received was to go for the third option if my knee was unstable and I didn’t trust it. As I saw it the answer to this was unclear, making it a marginal decision whether to go for the full reconstruction. I went for it in the end because I’m the sort of person who likes to get the fundamentals right and struggling along with the ACL fused in the wrong place with the accompanying increased risk of further knee collapse and early arthritis just didn’t feel like the best thing to do. The decision was also linked to my desire to stay fit in mind and body and keep exercising for as many years as possible. Not having a full operation would have meant giving up on that a little, something I’m not ready to do.

Happily, one day after the operation it looks like I made the right choice. At six weeks in a leg brace and on crutches the recovery time is much longer than anticipated, but paradoxically my chances of a fully functioning knee are better than we all expected going into the operation. The reason for the paradox is that they were able to repair the tear in the meniscus rather than just tidy the frayed edges. That should lead to a better end result, but for the time being the stitches are fragile and need to be protected.

I’m not yet sure what the longer recovery time means for my ability to get out and meet people. I had planned to work from home this week and be back in the office next week, but it may not be wise to leave here so soon. Certainly I think it will be unwise to travel on the Underground for a little while yet. My phone and email are working though.

I’m going to see how my knee heals this week and make a decision on Thursday or Friday about whether to spend next week working from home as well. After that I will be in touch with any of you who I’m due to meet, either to re-arrange or change the meeting to a Skype call.

As I sat waiting to go into surgery yesterday I wished I’d already posted about my decision to go for the operation. Writing afterwards like this inevitably has an air of post event rationalisation, and it would have been fun to post my reasons first and then see if I got it right afterwards. Still, I wanted to capture my thinking for posterity. I hope it’s been interesting.

christophjaggi

Just out of curiosity: What is the main culprit for the 6 weeks of leg brace and crutches: the ACL or the meniscus? If I remember correctly, up to the early 90s torn menisci were normally removed and not repaired/stiched together, although removing a meniscus has the risk of early arthritis, Having a torn meniscus stiched together at that time would lead to 6 weeks of crutches and at least 4 weeks of leg brace.